Hypertrophic scarring is one of the long-lasting effects of acute burns. Because burn scar tissue has altered vascularization, structural changes, increased tension, and contour abnormalities that go deep beneath the damaged surface layers of skin, pain and functional impairment may continue long after the initial treatment has ended.
The innovative use of fractionation of laser beam technology in dermatology has led to significant improvements in the treatment of burn scars, regardless of how mature. In an interview with Dermatology Advisor, Jill Waibel, MD, owner and medical director of Miami Dermatology and Laser Institute; subsection chief of dermatology, Baptist Hospital of Miami; chief of dermatology, Miami Cancer Institute; and assistant voluntary professor, University of Miami Miller School of Medicine in southern Florida, explains how fractional lasers are being employed and how they improve the outcomes of burns of all kinds. Photographs from Dr. Waibel’s practice illustrate the results her patients have seen.
Dermatology Advisor: What are the main benefits to ablative fractional resurfacing (AFR) compared with other laser technologies for the treatment of burn scars?
Dr Waibel: Fractional photothermolysis has been the most remarkable breakthrough in clinical laser science since selective photothermolysis. The human body can heal the smallest wound ever encountered (ablative fractional wound) in scar tissue, and the healing results in (almost) normal skin. Fractionated laser beams create microscopic wounds that reach greater dermal depths and promote a rapid healing effect. This method of skin resurfacing has led to clinical efficacy in aesthetic procedures and scar treatment with high physician and patient satisfaction.
How does AFR work?
In essence, AFR lasers create microscopic full-thickness wounds. The mechanism of action for ablative fractional therapy is complex: with temperatures reaching more than 100°C, the treated areas of the epidermis and dermis are vaporized. Elimination of damaged epithelia and shrinkage of collagen fibers occurs immediately after ablation. During the next 3 to 6 months, the series of wounds created leads to newly synthesized collagen and granulation tissue, followed by eventual regeneration of the epidermis. Repeated treatments have continued effects, the greatest on collagen formation. Most of our patients who undergo combination therapy with multiple lasers and injectables need between three to six treatment sessions.
What are the drawbacks?
Based on the literature, clinical trials, and experience, the ablative fractional laser is the gold standard for laser treatment of burn and trauma scar because of its ability to create the most neocollagenosis of any of our current laser devices. Drawbacks to the AFR include cost of laser and discomfort during the procedure, which can be managed. It takes 7 to 10 hours for postoperative healing. Patients can return to work or school, in most cases, 24 to 48 hours after laser sessions.
When in the treatment process do you see burn patients?
Typically, patients receive care initially from our colleagues: burn and trauma surgeons and reconstructive surgeons. Once released from surgical care, patients should find a board-certified laser physician who is a laser expert. Burn and trauma scars are complex and need experienced laser practitioners who understand laser-tissue physics as well as the complexities of burn and trauma injuries including scars, range of motion, symptoms, and psychological challenges these patients face.